Abstract: Objective:To investigate the application value of dynamic single-photon emission computed tomography (SPECT) 99m-technetium galactosyl human serum albumin diethylenetriamine pentaacetic acid injection (⁹⁹Tc^m-GSA) scintigraphy assessing regional liver function changes before and after portal vein embolization (PVE).
Methods:The retrospective cross-sectional study was conducted. The clinical data of 11 patients with Bismuth Ⅲa hilar cholangiocarcinoma who were admitted to the General Hospital of People′s Liberation Army (10 patients) and Beijing Tsinghua Changgung Hospital (1 patient) from October 2010 to October 2016 were collected. B ultrasound-guided percutaneous transhepatic ipsilateral exbolization was performed before radical resection of hilar cholangiocarcinoma. Dynamic SPECT ⁹⁹Tc^m-GSA scintigraphy was performed to calculate and compare the changes of functional liver volume (FLV), morphological liver volume (MLV) and functional liver density (FLD) in embolized lobe and non-embolized lobe before PVE and 2 weeks after PVE. Observation indicators: (1) the changes of serum indexes in 2 weeks before and after PVE; (2) the changes of FLV, MLV and FLD in the whole liver, embolized and non-embolized lobes in 2 weeks before and after PVE; (3) surgical and postoperative situations of hilar cholangiocarcinoma; (4) follow-up and survival situations. Follow-up using outpatient examination and telephone interview was performed to detect postoperative serum toal bilirubin (TBil) level, with or without peritoneal effusion and survival up to June 2017. Measurement data with normal distribution were represented as ±s. The comparisons of pre-and post-operative data were analyzed by the paired t test.
Results:(1) The changes of serum indexes in 2 weeks before and after PVE: 11 patients underwent successful right PVE. The alanine aminotransferase (ALT), TBil, albumin (Alb), Platelets (PLT) and prothrombin time (PT) were respectively (113±20)U/L, (73±8)μmol/L, (35.0±2.5)g/L, (209±58)×109/L, (11.4±0.7)seconds in 2 weeks before PVE and (120±18)U/L, (36±7)μmol/L, (34.4±3.2)g/L, (224±82)×109/L, (11.2±0.8)seconds in 2 weeks after PVE, with a statistically significant difference in TBil level (t=-10.592, P<0.05) and no statistically significant difference in ALT, Alb, PLT and PT (t=0.981,-0.350,-0.591, 0.533, P>0.05). (2) The changes of FLV, MLV and FLD in the whole liver, embolized and non-embolized lobes in 2 weeks before and after PVE: the FLV, MLV and FLD of the whole liver were respectively (894±255)mL,(1 552±504)mL, 0.59±0.14 in 2 weeks before PVE and (812±206)mL, (1 521±422)mL, 0.55±0.16 in 2 weeks after PVE, with no statistically significant difference (t=1.569, 0.666, 1.980, P>0.05). The FLV, MLV and FLD of the embolized lobe were respectively (623±275)mL, (1 047±394)mL, 0.62±0.14 in 2 weeks before PVE and (375±240)mL, (865±337)mL, 0.44±0.24 in 2 weeks after PVE, with statistically significant differences (t=5.909, 3.736, 3.359, P<0.05); the descending percentages were respectively 38.1%, 9.8% and 24.6%. The FLV, MLV and FLD of the non-embolized lobe were respectively (274±152)mL, (530±176)mL, 0.52±0.21 in 2 weeks before PVE and (436±149)mL, (656±133)mL, 0.68±0.24 in 2 weeks after PVE, with statistically significant differences (t=-6.019, -6.345, -3.933, P<0.05); the elevated percentages were respectively 80.1%, 19.9% and 23.8%. (3) Surgical and postoperative situations of hilar cholangiocarcinoma: of 11 patients, 10 received successful peri-hilar right hemihepatectomy, the right hepatic atrophy and an obvious demarcation line between left and right liver were found intraoperatively; 1 stopped operation due to detect intraoperatively peritoneal metastasis of tumor. The operation time, volume of intraoperative blood loss and time of postoperative abdominal drainage-tube removal were respectively (585±194)minutes, (472±274)mL and (8±5)days. Of 10 patients undergoing operations, 2 were complicated with massive peritoneal effusion at 2 days postoperatively, volume of peritoneal effusion remained more than 500 mL up to 7 days after drainage, and were improved by 1- month conservative treatment; other 8 patients were not complicated with hepatic dysfunction. Duration of hospital stay of 11 patients was (16±4)days. (4) Follow-up and survival situations: 10 patients were followed up for 4-72 months, with a median time of 39 months. During the follow-up, there was no evaluated TBil level and peritoneal effusion in 10 patients. The median survival time, 1-,3- and 5-year overall survival rates were 88.8%, 74.6% and 36.8%, respectively.
Conclusions:The dynamic SPECT ⁹⁹Tc^m-GSA scintigraphy can effectively evaluate liver function changes of embolized and non-embolized lobes before and after PVE. The increased rate of FLV of non-embolized lobe is higher than that of MLV.